Abstract PTSDandchronicpainarehighlyprevalentandeachisassociatedwithlong-termdisabilityand substanceabuse,exactingenormousemotional,functional,andfinancialtollsonindividualsandsociety. PTSDandchronicpainarefrequentlyco-morbidwithoverlapbetween20%and70%,representingan enormouspublichealthproblem.However,ourunderstandingofthemechanismsbywhichPTSDandchronic painbecomeintertwinedislimited.ThemajorityofstudiesofthePTSD/chronicpainco-morbidityarecross- sectional,andfocusedonasinglechronicpaincondition,limitingcausalinferencesandgeneralizabilityto otherchronicpainconditions.Chronicpainisalsorelatedtoahighprevalenceofsubstanceabuse.To understandhowtrauma-relatedPTSD,andresilienceandvulnerabilityfactorscontributetothetransitionfrom acutetochronicpainanddevelopmentofsubstanceabuserequiresprospectivedesigns.Suchresearchis vitalamonginner-cityAfricanAmericanwomen,whoaremorelikelytoexperiencetraumaticstressandpain, butarelesslikelytobetreatedappropriately;?aphenomenonperhapsleadingtogreaterriskfordisabilityand substanceabuse.Weproposetoexamine3modelsrelatedtothedevelopmentofPTSD/chronicpainpairing anddevelopmentofsubstanceabuseinpeopleinitiallypresentingwithacutepain(notcausedbyatraumatic event)ina6-monthprospectivedesign.FirstistheMain Effects Model inwhichthelevelofPTSDsymptoms atbaselinewillpredictthelikelihoodofatransitionfromacutetochronicpainanddevelopmentofsubstance abuseat6months.SecondistheModeration Model inwhichbaselinevulnerabilityandresiliencefactors interactwithPTSDsymptomstopredictthelikelihoodofdevelopingchronicpainandsubstanceabuse6 monthslater.ThirdistheMediator Model inwhichrelationshipsbetweenbaselinelevelsofPTSDsymptoms andthedevelopmentofchronicpainandsubstanceabuse6monthslateraremediatedbyvulnerabilityand resiliencefactorsat3months.Inner-citywomen(N=600)presentingtoanEmergencyDepartmentwitha complaintofacutebodilypain,ages18-40yrs,willberecruited.Onlywomenpresentingwithacute pelvic/abdominal,neck/shoulderorlowbackpain,andwhodonothaveachronicpainhistorywillbeenrolled. Wewillassesstraumaexposure,PTSDsymptoms,painsensitivity,substancedependenceandabuse,acute painandpsychosocialresilienceandvulnerabilityfactorsacross3waves(baseline,3-and6-months),and obtainadditionalphoneassessmentofpainintensityandinterferenceat1-,2-,4-,and5-months.Inner-city womenwerechosenbecauseoftheirhighlikelihoodofexposuretoongoingtraumaticeventsandthe opportunitytoilluminateahealthdisparityinvolvingthePTSD/chronicpainpairingamonginner-cityminority womeninparticular.Thepublichealthproblemposedbyco-morbidPTSD,chronicpainandsubstanceabuse cannotbeoverstated,particularlyasitimpactshealthdisparitiesintheUS.Greaterunderstandingofhow PTSDmayincreasethelikelihoodoftransitioningfromacutetochronicpainanddevelopingsubstanceabuse, whichfactorscontributetothesedevelopments,andwhichpeoplemaybemostvulnerablewillallowmore timelyclinicalinterventionsonaccuratelyidentifiedtargetstohelpforestallthedevelopmentoftheselargely intractableconditions.